Technical Considerations in Awake Craniotomy with Cortical and Subcortical Motor Mapping in Preadolescents: Pushing the Envelope

2021 ◽  
Vol 56 (2) ◽  
pp. 171-178
Author(s):  
Vishwaraj Ratha ◽  
Nishanth Sampath ◽  
Sudhakar Subramaniam ◽  
V.R. Roopesh Kumar
Keyword(s):  
Perioperative Complications ◽  
Pediatric Population ◽  
Awake Craniotomy ◽  
Neurophysiological Monitoring ◽  
Age Group ◽  
Neurological Assessment ◽  
Case Presentation ◽  
Motor Mapping ◽  
Combined Application ◽  
Subcortical Mapping

<b><i>Introduction:</i></b> Unlike adult gliomas, the utility of combined application of awake anesthesia and intraoperative neurophysiological monitoring (IONM) for maximal safe resection in eloquent region gliomas (ERG) has not been established for pediatric population while it remains unexplored in preadolescents (below 11 years old). <b><i>Case Presentation:</i></b> We report 2 cases of awake craniotomy with IONM in an 8 and 9 year old for safe maximal resection of ERG. In both the cases, repeated preoperative visits of the operating room was performed to familiarize and educate the children about intraoperative communication, comfortable positioning, and neurological assessment. Under conscious sedation protocol, cortical and subcortical mapping, and electrocorticography, gross total resection was achieved. In both the cases, there were no postoperative neurodeficits or perioperative complications. <b><i>Conclusion:</i></b> Our 2 cases illustrate the first instance of successful use of awake IONM for maximal safe resection of ERG in preadolescent age-group. We believe, with proper preoperative planning and careful titration of anesthetics, it is safe and feasible. The blanket notion that preadolescent age-group should be excluded from awake mapping needs to be challenged, rather curated on a case basis.

scholarly journals Paranasal Mass in a Healthy Male Toddler

2021 ◽  
pp. 014556132110079
Author(s):  
Melonie Anne Phillips ◽  
Meredith Lind ◽  
Gerd McGwire ◽  
Diana Rodriguez ◽  
Suzanna Logan
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Age Group ◽  
Significant Morbidity ◽  
Healthy Male ◽  
Neck Tumors ◽  
Complete Surgical Resection ◽  
Maxilla And Mandible ◽  
Benign Mass

Head and neck tumors are rare in pediatric patients but should be kept in the differential when a patient presents with a new swelling or mass. One of these tumors is a myxoma, which is an insidiously growing, benign mass originating from the mesenchyme. They most commonly arise in the myocardium but can also develop in facial structures, particularly in the maxilla and mandible. When arising in facial structures, ocular, respiratory, and digestive systems can be affected based on local invasion. Complete surgical resection is curative but can lead to significant morbidity as well. Here, we present a case of a 15-month-old toddler presenting with a paranasal mass, which was ultimately diagnosed as a maxillary myxoma. This tumor is very rare in the pediatric population, especially in the toddler age-group, reminding clinicians to broaden the differential diagnosis when a patient’s course is atypical.

scholarly journals Oncological and functional outcomes of supratotal resection of IDH1 wild-type glioblastoma based on 11C-methionine PET: a retrospective, single-center study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seiichiro Hirono ◽  
Ko Ozaki ◽  
Masayoshi Kobayashi ◽  
Ayaka Hara ◽  
Tomohiro Yamaki ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Awake Craniotomy ◽  
Rank Test ◽  
Wild Type ◽  
Log Rank Test ◽  
Positron Emission ◽  
Single Center Study ◽  
Supratotal Resection ◽  
Subcortical Mapping

AbstractThe oncological and functional outcomes in glioblastoma (GBM) patients following supratotal resection (SupTR), involving complete resection of contrast-enhancing enhanced (CE) tumors and areas of methionine (Met) uptake on 11C-met positron emission tomography (Met-PET), are unknown. We conducted a retrospective review in newly diagnosed, IDH1 wild-type GBM patients, comparing SupTR with gross total resection (GTR), in which only CE tumor tissue was resected. All patients underwent standard radiotherapy and temozolomide treatment, and were followed for tumor recurrence and overall survival (OS). Among the 30 patients included in this study, 7 underwent SupTR and 23 underwent GTR. Awake craniotomy with cortical and subcortical mapping was more frequently performed in the SupTR group than in the GTR group. During the follow-up period, significantly different patterns of disease progression were observed between groups. Although more than 80% of recurrences were local in the GTR group, all recurrences in the SupTR group were distant. Median OS in the GTR and SupTR groups was 18.5 months (95% confidence interval [CI] 14.2–35.1) and not reached (95% CI 30.5-not estimable), respectively; this difference was statistically significant (p = 0.03 by log-rank test). No postoperative neurocognitive decline was evident in patients who underwent SupTR. Compared to GTR alone, aggressive resection of both CE tumors and areas with Met uptake (SupTR) under awake craniotomy with functional mapping results in a survival benefit associated with better local control and neurocognitive preservation.

scholarly journals Recurrent schwannoma of the tongue in a pediatric patient—report of a rare case with an updated review of literature

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Anup Singh ◽  
Vaisakh Kuzhikkali ◽  
Arvind Kumar Kairo
Keyword(s):  
Pediatric Population ◽  
Surgical Excision ◽  
Review Of Literature ◽  
Case Presentation ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Cervical Sympathetic ◽  
Mobile Tongue

Abstract Background Head and neck is a relatively common site of occurrence for the peripheral nerve sheath tumors, and majority of these tumors are seen involving neck, involving vagus nerve, and cervical sympathetic chain. Schwannomas involving mobile tongue are rarely encountered, especially in the pediatric population Case presentation We present a case of recurrent tongue schwannoma in a 13-year-old female successfully managed with transoral excision. At a follow-up of 3 years, no recurrence is observed. Conclusion Surgical excision is the recommended modality of treatment for lingual schwannomas, and when excised adequately, recurrences are not expected. A clear margin of surrounding normal tissue should be aimed for to avoid possible recurrence.

scholarly journals Neurological manifestation of Vitamin D deficiency

2021 ◽  
pp. 430-432
Author(s):  
Saniya Sroa ◽  
Shweta Nair ◽  
Fehmida N ◽  
Amit Vatkar
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Pediatric Population ◽  
Pseudotumor Cerebri ◽  
Neurological Manifestation ◽  
Age Group ◽  
Pediatric Age Group ◽  
Pressure Headache ◽  
Common Deficiency ◽  
Visual Disturbances

Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder with raised intracranial pressure, headache, papilledema, visual disturbances with a normal cerebrospinal fluid examination, and normal neuroimaging. It is rare in the pediatric population and may occur as a manifestation of underlying disorders. Vitamin D deficiency is a common deficiency in the pediatric age group. However, neurological manifestations are rare. Here, we present the case of a 5-year-old male child who presented with headache, vomiting, and hypertension; however, the neurological examination was normal but the neuroimaging was suggestive of pseudotumor cerebri. Appropriate investigations were done. The most likely cause of pseudotumor cerebri in this patient was the deficiency of Vitamin D. We have reported this case as pseudotumor cerebri is a rare neurological manifestation of Vitamin D deficiency.

scholarly journals A neurosurgical challenge: awake mapping in „critical” language area tumours

2019 ◽  
pp. 355-362
Author(s):  
Mihaela Cosman ◽  
Ionut Mihail Pantiru ◽  
Bogdan Florin Iliescu ◽  
Nina Straticiuc ◽  
Iulia Aldea ◽  
...  
Keyword(s):  
Technological Development ◽  
Progression Free Survival ◽  
Epileptic Seizures ◽  
Awake Craniotomy ◽  
Male Dominance ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Tumour Resection ◽  
Presenting Symptoms ◽  
Language Area

Introduction. Despite the technological development lesion located in or near language area still represent a challenge for every neurosurgeon. Awake craniotomy and intraoperative neurophysiological monitoring come to our help. Different techniques variation exists among specialized centres. We present our experience and the set up for this procedure. Materials and methods. We conducted a retrospective analysis of collected data from 10 patients with brain tumours located in or near language area to which we performed awake craniotomy and intraoperative neurophysiological monitoring. They were admitted in Third Department of Neurosurgery,” Prof. Dr. N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results. Presenting symptoms had a duration more than a month in 60 % of patients. In 80% of them were represented by epileptic seizures and the rest of 20 % had transient aphasia elements. The median age of presentation was 28 years old with a male dominance. The histological reports indicated: fibrillary astrocytoma – 40%, anaplastic astrocytoma – 30%, oligodendroglioma – 20% and metastases – 10%. Gross total resection was performed in half of the cases and subtotal in just one case, in which the spontaneous speech and object naming showed repeated impairment in time of tumour debulking. The surgical intervention was well tolerated by all the patients. The intensity of cortical stimulation used was between 4 – 10 mA. Postoperatively two patients had neurological aggravation, with full recovery at 3 months follow up period, two were stationary and six had symptoms remission. Conclusion. A young age of presentation, a paucity of symptoms, the chance for an increase in overall survival and progression free survival impose the need for direct communication and feedback with the patient in time of tumour resection. Thus, awake craniotomy and intraoperative neurophysiological monitoring is the golden standard for selected cases of language area tumours.

Reference intervals for follicle-stimulating hormone, luteinizing hormone and prolactin in children and young adults on the bioMérieux Mini-Vidas system

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Thu Koskas ◽  
Karamo Souaré ◽  
Tarik Ouahabi ◽  
Dominique Porquet ◽  
Didier Chevenne
Keyword(s):  
Luteinizing Hormone ◽  
Pediatric Population ◽  
Follicle Stimulating Hormone ◽  
Reference Intervals ◽  
Age Group ◽  
Pubertal Stage ◽  
Significant Difference ◽  
Class 1 ◽  
Children And Young Adults ◽  
Stimulating Hormone

AbstractWe measured serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin concentrations on a bioMérieux Mini Vidas system in a pediatric population ranging in age from 1 to 19 years. Reference intervals were established separately for females and males, with stratification by age group and by Tanner's pubertal stage. FSH values were higher in females than in males, and were lowest in both sexes of age class 2 (4–8 years), increasing thereafter to the upper limit for stage PIV (females) and stage PV (males). LH values showed a similar pattern of change: concentrations were lowest for class 1 (1–3 years) and class 2 (4–8 years), and highest for stage PII (females) and stage PV (males). No significant difference was observed according to gender. Prolactin values did not differ markedly according to gender or pubertal status.Clin Chem Lab Med 2007;45:541–5.

Neurophysiological Monitoring and Awake Craniotomy for Resection of Intracranial Gliomas

2017 ◽  
pp. 117-158 ◽  
Author(s):  
Taiichi Saito ◽  
Manabu Tamura ◽  
Mikhail F. Chernov ◽  
Soko Ikuta ◽  
Yoshihiro Muragaki ◽  
...  
Keyword(s):  
Awake Craniotomy ◽  
Neurophysiological Monitoring

scholarly journals Scaphoid Fractures below the Age of 10: Case Series and Review of the Literature

2020 ◽  
Vol 9 (06) ◽  
pp. 458-464
Author(s):  
Rachana Tataria ◽  
Jeannette Ting ◽  
Andrea Jester ◽  
Tommy R. Lindau ◽  
Kerstin Oestreich
Keyword(s):  
Pediatric Population ◽  
Age Groups ◽  
Case Series ◽  
Final Diagnosis ◽  
Scaphoid Bone ◽  
Age Group ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
Fractures In Children ◽  
Common Location

Abstract Background Scaphoid fractures are relatively uncommon in children, especially below the age of 10 due to the ossification of the scaphoid bone, which starts around 4 to 6 years of age and continues until 13 to 15 years of age, where pediatric scaphoid fractures peak. This makes the diagnoses challenging in this age group. Methods The primary aim of this study was to analyze prospectively collected data in managing scaphoid fractures. All cases in children up to the age of 10 years, treated in a tertiary pediatric hand and upper limb from January 2014 to June 2018 were included. Parameters studied were patient demographics, clinical presentation, mechanism of injury, investigations, type of fracture, associated injuries, treatment offered, outcomes and complications. The secondary aim was to review the literature due to the limited knowledge about these fractures in these low age groups. Results A total of 23 patients with documented scaphoid fractures in children up to the age of 10 years were found. Final diagnosis in all these patients was done with magnetic resonance imaging (MRI). The mean age was 9.8 years, with female preponderance. Scaphoid waist was the most common location. Five patients had associated fractures of the capitate and one patient had associated second metacarpal base fracture. All patients were managed nonoperatively. The average time of immobilization was 6.6 weeks (range: 4–10 weeks). A majority of patients had minor symptoms after the fracture, most likely due to the immobilization time. Conclusion Scaphoid fractures are rare in the pediatric population up to the age of 10. MRI is most often needed to confirm diagnosis. Nonoperative management of most scaphoid fractures in this age group is safe and feasible with no significant long-term morbidity. Surgical management of scaphoid fractures might be required in very selected cases. Level of Evidence This is a Level IV study.

Awake craniotomy in pediatric population is possible!

2020 ◽  
Vol 30 (6) ◽  
pp. 722-722
Author(s):  
Hemanshu Prabhakar ◽  
Charu Mahajan ◽  
Indu Kapoor
Keyword(s):  
Pediatric Population ◽  
Awake Craniotomy

scholarly journals Familial oral lichen planus in a 3-year-old boy: a case report with eight years of follow-up

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fang Wang ◽  
Ya-Qin Tan ◽  
Jing Zhang ◽  
Gang Zhou
Keyword(s):  
Lichen Planus ◽  
Oral Mucosa ◽  
Buccal Mucosa ◽  
Oral Lichen Planus ◽  
Familial Aggregation ◽  
Pediatric Population ◽  
Case Presentation ◽  
Oral Lichen

Abstract Background Oral lichen planus (OLP) is a chronic mucocutaneous disease characterized by adult predominance and a prolonged course. However, it is rare in the pediatric population with familial aggregation. Case presentation A 3-year-old boy presented with pain and irritation on the oral mucosa while contacting spicy food for 2 months. Oral examination showed widespread whitish reticular and papular lesions on the lips, the dorsum of the tongue, and bilateral buccal mucosa, with diffuse erosions covered with pseudomembrane on the buccal mucosa. The boy’s parents were examined to exhibit white reticular and plaque-like lesions on their oral mucosa. The three patients were clinically diagnosed as affected by OLP and histopathologically confirmed. The boy underwent topical treatment with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel, and oral lesions gradually resolved and healed. Neither of his parents received treatment. During the subsequent follow-ups, none of three patients underwent any medical treatment. Fortunately, their lesions had almost faded over 8 years. Conclusions Our case emphasizes that pediatric OLP should be recorded with family history. Besides, long-term periodic follow-up is recommended in pediatric patients with OLP for monitoring any changes in lesions.

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